A systematic review of research methodology in telemedicine studies

Abstract

We conducted a systematic review of 15 relevant databases for articles about telemedicine. After eliminating articles that did not meet the inclusion criteria, 1615 remained for analysis. Three raters coded the articles to assess various theoretical and methodological variables. Only 5% (n = 85) of the telemedicine articles made mention of any theory or paradigmatic approach. Studies commonly reported the objectives (96%) but rarely stated a research question or hypothesis (11%). Randomized selection of the subjects was reported in 11% of patient studies and 4% of studies where providers were the subject. There was a wide range in the number of subjects employed, although the majority of studies were based on sample sizes of less than 100. Only 26% of the studies reported a time frame. Until the telemedicine field adheres to agreed standards of reporting methodological details it will be difficult to draw firm conclusions from review studies.

The Use of Telemedicine to Address Access and Physician Workforce Shortages

“…In comparative studies involving telemedicine, the use of randomized designs is preferable and, to date, underutilized; it may be appropriate under certain circumstances to randomize one or more of patients, physicians, or delivery sites. [55][56][57] CURRENT BARRIERS TO TELEMEDICINE The implementation of telemedicine requires an initial financial investment in equipment, software, and telecommunications. There are often ongoing costs associated with maintenance of technology and personnel costs associated with training and technical support.…”

Custo-benefício do serviço de telecardiologia no Estado de Minas Gerais: projeto Minas Telecardio

“…The ECG transmitted to distant locations by different methods, such telephone and internet can be used in different clinical situations. While there have been several experiences of tele-electrocardiography in Brazil and in the world 5,6 , there are limited data about the feasibility and economic benefit of its implementation in the public health system as support to primary healthcare 5,7 . Molinari et al 14 described the experience with 106,942 patients in Italy, in which the ECG was performed to clarify the cardiovascular symptoms or in routine consultations, but they did not describe any eventual economic benefits.…”

“…Telemedicine is the practice of Medicine at distance by means of telecommunications 3 . Several countries have used the services of tele-healthcare as an alternative treatment 4,5 , including cases of cardiovascular diseases 6 . However, the methodological quality of most studies in telemedicine and telecardiology has been considered questionable 5,7 and are not enough to prove any eventual economic benefits of telecardiology 7 .…”

Measuring the ‘success’ of telehealth interventions

“…Robust trials are not routine in this area and Whitten et al in their paper of research methodologies in telehealth suggest the recruitment of participants through randomised means is only present in 11% of patient studies and the majority of studies involve sample sizes of less than 100 (Whitten et al, 2007). Yet the level of evidence required by decision makers is often at the individual RCT level or higher.…”